Traditionally, treatments performed for reasons of medical necessity have been covered by insurance, while those performed for cosmetic reasons are paid for by the patients. The third group of conditions has been a “gray” area, with insurance sometimes covering the costs of treatment and other times the responsibility falling on the patient. Today, with increasing tightening of purse strings by insurance companies, the responsibility for payment of even those procedures performed out of medical necessity or to correct birthmarks or scarring caused by injury or surgery may fall upon the patient.